Gut Check: Blame Rests Within

The outbreak of Salmonella Saintpaul has drawn outcry from the media, knee-jerk proposals from lawmakers, and understandable fear and confusion among consumers. As with outbreaks in the past, the Food and Drug Administration (FDA), Centers for Disease Control and Prevention (CDC), and processing plants and farmers continue to take the blame for tainted food making us ill. But does our All-American sick gut deserve some blame as well?

While our attention is focused on farm-to-table food safety and disease surveillance once we have gotten sick, the biological question of why we got sick is ignored.

Most experts would readily acknowledge that the detecting of the small numbers of pathogenic bacteria and viruses in billions of pounds of food is an insensitive prevention strategy at best. Likewise, once an outbreak has been detected, finding the source of the offending pathogen can prove difficult, as the Salmonella Saintpaul outbreak demonstrated. While good farming practices, sampling and testing for detection and tracking down the bad bug once an outbreak has been recognized are critical to a safe food supply, understanding why a person succumbs to a very small number of initial organisms may be a relevant question.

By adding the biological question of why our natural defenses failed, we correctly insert personal responsibility into our national strategy. More importantly, we draw attention to the much larger public health crisis, of which illness from food-borne pathogens is only a symptom: our sick, leaky guts.

The CDC warns, "The elderly, infants, and those with impaired immune systems are more likely to have a severe illness" associated with tainted food. Within the complex network of specialized cells and organs that work together to defend against attacks from foreign invaders like Salmonella, something has gone wrong, increasing risk of getting sick.

A critical component to a properly functioning immune system is a healthy and balanced population of bacteria. Bifidobacterium, lactobacillus and other natural inhabitants of the human gut make it their evolutionary job to fight invaders by competing for nutrients (which the invader needs to survive), competing for attachment sites on our intestinal walls (which the invader must find to cause harm), producing organic acids (that the invader does not like) and changing the pH of the intestinal ecosystem (which the pathogen does not like either, but is adapting to quickly).

This germ-on-germ warfare is literally fought daily in the American gut. When the good guys lose, we know this as diarrhea, fever and abdominal cramps. While this germ warfare has raged in the human gut as long as humans have been around, the rules of the battle are changing as humans have shifted to a highly processed diet that has changed the nutrient supply that our friendly microbes evolved to depend on.

The irony of the public running from vegetables and fruits that have been suspected in the outbreak is that these foods contain essential nutrients (dietary fiber) that our gut bugs need to fight the good fight. Our change in diet, coupled with uncontrolled use of antibiotics, may be adversely altering our organic relationship with our most important weapon against food-borne pathogens.

The disruption and increased gut infections caused by pathogens possibly have an irreversible impact on our entire gastrointestinal system. Mounting evidence suggests acute and chronic infection by pathogens damage the delicate mucosal barrier that separates trillions of bacteria in our intestinal system from the sterile environment of our blood. As the steady flow of lost battles accumulate, the barrier and our whole immune system become impaired, resulting in inflammation and movement of pathogens and endotoxins into our sterile blood. An impaired and leaky gut barrier plays an important role in a range of maladies such as irritable bowel disease, some cancers, sepsis, organ failure, heart disease and a cascade of other metabolic disorders.

By inserting personal responsibility and some basics of host-pathogen germ warfare into the equation, we may start to realize that we may not simply be experiencing a mathematical rise in food-borne illness as a result of sloppy farming and poor government oversight. Rather a tectonic-like shift in our nutritional landscape has opened the pathogens door just enough for us to glimpse into the future of human suffering. Just the thought makes my gut ache.

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